| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,136 |
1,106 |
$280K |
| D1351 |
Sealant - per tooth |
9,359 |
1,708 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
4,470 |
4,344 |
$118K |
| D1110 |
Prophylaxis - adult |
1,954 |
1,876 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
718 |
714 |
$94K |
| D1120 |
Prophylaxis - child |
2,704 |
2,637 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,791 |
4,654 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
825 |
414 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,232 |
2,137 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,939 |
1,768 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
846 |
819 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
251 |
96 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
856 |
810 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,251 |
1,217 |
$25K |
| D0330 |
Panoramic radiographic image |
1,207 |
1,153 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
404 |
201 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
105 |
$16K |
| D0350 |
|
1,066 |
950 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
604 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
661 |
473 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
88 |
$2K |
| D0603 |
|
6,015 |
5,887 |
$0.87 |
| D0601 |
|
120 |
120 |
$0.00 |
| D0602 |
|
195 |
188 |
$0.00 |